CMS releases proposed 2017 physician payment rule

The Centers for Medicare & Medicaid Services late today issued its proposed rule for the physician fee schedule for calendar year 2017. After application of the 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015 and other budget neutrality cuts, CMS estimates a 0.08% decrease in physician payment rates for 2017 compared to 2016. In addition, CMS proposes to pay for new telehealth services, including end-stage renal disease-related services for dialysis, advance care planning services and critical care consultations, and to expand the Center for Medicare & Medicaid Innovation Diabetes Prevention Program model. The agency also proposes a number of new codes to more accurately pay for primary care, care management and other cognitive specialties, including separate payments to primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. With respect to Medicare Advantage, CMS proposes to require health care providers and suppliers to be screened and enrolled in Medicare in order to contract with and provide items and services through a MA organization. The agency also proposes to release two new sets of data related to MA and Part D prescription drug plans: one including information on the bids that MA plans submit, which reflect their estimated costs of providing benefits to enrollees, and another including information on MA and drug plans’ medical-loss ratios. Other proposals include changes to the quality measurement requirements of the Medicare Shared Savings Program, including revisions to the measure set, data validation process and scoring methodology; a change to allow individual eligible professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System, and to have that data used in PQRS in the event the MSSP ACO fails to report quality data; and updates to the informal review process used in the physician value modifier program. The proposed rule will be published in the July 15 Federal Register, and comments are due Sept. 6. AHA members will receive a Special Bulletin with further details tomorrow.